Evaluating clinical criteria in patients being referred for a pre-operative chest X-ray in a state general hospital in Malta

Abstract

Objectives: A pre-operative chest x-ray (CXR) is a radiological investigation widely used before surgeries. The objective of this study was to determine patient clinical referral criteria for pre-operative CXRs and to investigate if referrals adhered to the local, European and/or international guidelines for requesting such X-rays. The reports of the CXRs were also compared to the referral criteria used. Methods: In this prospective cross-sectional study, 271 participants were recruited using convenience sampling. Adult patients performing a pre-op CXR prior to an elective surgery were recruited by intermediaries. Medical and clinical information of patients was obtained through a self-designed close-ended questionnaire and complimented by a data sheet. Results: 41 (15%) participants had an abnormality on the pre-operative CXR, and the prevalence of abnormalities increased with an increasing American Society of Anaesthesiology (ASA) score. However, within all ASA populations the absence of abnormalities on the pre-operative CXR was significantly high. Cardiomegaly was the most common abnormality accounting for 24.3% (n=10) of findings. Moreover, a significant association was found (p=0.007) between increasing age and CXR abnormalities whilst no significant association was registered between the presence of cardiopulmonary diseases or risk factors and abnormalities detected on a CXR. Conclusions: In 36 patients the abnormalities detected on the pre-op CXR were coexistent with co-morbidities or risk factors and could have been diagnosed on a physical exam and through a clinical history. Consequently, 64.2% of CXRs were not requested in accordance with the local guidelines whilst 70.1% of CXRs were not requested according to the European and international guidelines.